Provider Demographics
NPI:1164548996
Name:ROCKVILLE AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ROCKVILLE AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FLAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-340-8666
Mailing Address - Street 1:50 W EDMONSTON DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1228
Mailing Address - Country:US
Mailing Address - Phone:301-340-8666
Mailing Address - Fax:301-340-7448
Practice Address - Street 1:50 W EDMONSTON DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1228
Practice Address - Country:US
Practice Address - Phone:301-340-8666
Practice Address - Fax:301-340-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1154261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
X14699Medicare UPIN
MD309955Medicare ID - Type Unspecified